The Coming Antibiotic-Resistance Pandemic that Could Make COVID Look Like
the Flu
While the Global South overprescribes antibiotics, in the West farm animals
are pumped full of them, farmers even giving them to healthy animals so they
can be packed tighter in ever-increasing herd sizes.
by Alan Macleod
April 06th, 2021
Mint Press
By Alan Macleod
GENEVA - Big pharmaceutical companies have not come out of COVID-19 looking
like model global citizens. Pfizer has been accused of bullying South
American governments after demanding they put up military bases as
collateral in exchange for vaccines. Meanwhile, Bill Gates persuaded Oxford
University to sign an exclusive deal with AstraZeneca for its new offering,
rather than allow it to be copied freely by all. The British/Swedish
multinational quickly announced it would fall 50 million vaccines short on
its first shipment to the European Union.
But what if there were a looming health crisis that could make COVID look
almost minor in comparison? The World Health Organization (WHO) has been
warning of just such a case for some time now, predicting that antimicrobial
resistance will kill up to 10 million people every year by 2050 - almost
four times as many as the coronavirus has killed in the past 12 months.
"Antibiotic resistance is one of the biggest threats to global health, food
security, and development today," they write, noting that without effective
antibiotics all manner of conditions - including pneumonia, tuberculosis,
gonorrhea, and salmonellosis - could become far more deadly. Drug companies
are making this situation worse by encouraging the overuse of our precious
stores of antibiotics, particularly in the Global South and also by refusing
to invest enough resources into creating new ones.
Global overuse
The more antibiotics are used, the more resistant bacteria become to them,
meaning that humanity must guard its reserves and slow down the pathogens'
adaptive evolution by using them only when necessary. Between 2000 and 2015,
antibiotic consumption decreased by 4% in rich nations but increased by 77%
in developing ones, and their overuse has become rampant across the world.
The poorer enforcement of medical laws in these countries leads
manufacturers to "adopt unethical marketing approaches and develop creative
ways to incentivize prescribing among healthcare providers," in the words of
Dr. Giorgia Sulis, an infectious disease physician and epidemiologist at
McGill University, Quebec.
As Sulis explained to MintPress:
India is perhaps the best example in this regard, due to its large
pharmaceutical market and the predominant role of the private sector in
healthcare delivery. A private sector that is highly fragmented and largely
unregulated, where a substantial proportion of providers lack any sort of
formal medical training, is extremely vulnerable to [these kinds] of bad
business strategies."
Superbugs already kill an estimated 58,000 babies inside the country each
year.
While India does have a national healthcare system, it is chronically
understaffed and underequipped, leaving most of the population to rely on
one of the millions of informal providers - health workers who have no
official qualifications. Informal providers vastly outnumber trained
professionals.
"There is a very haphazardly integrated type of medicine, which is practiced
all over India. We have a professionalized modern healthcare system with
regulations. But it is a system that is limited" in its size and scope,
explained the London School of Hygiene and Tropical Medicine's Meenakshi
Gautham, an expert on antibiotic use in South Asia. "Informal providers or
para-health workers are the ones who continue to meet the healthcare needs
of millions of people who don't have access to the formal health system."
India Antibiotics
A man sorts through a bag of expired and partially used medication in New
Delhi. Saurabh Das | AP
These informal providers are a goldmine of profits for big pharma. A 2019
study by the Bureau of Investigative Journalism found that a host of drug
companies ply them with cash incentives, gift cards, medical equipment,
vacations, televisions, free samples, and discounts on bulk purchases - all
of which were intended to increase antibiotic use, thereby risking
overprescription. Some salesmen admitted to undercover reporters that they
knew the drugs were being misused, but that they were motivated purely by
profit. They also revealed that they would promote drugs to informal
providers based on their profitability, not their efficacy.
These informal workers are commonly written off derisively as "quacks" who
give out treatments mindlessly. While Dr. Gautham's work found that they
often do have major holes in their medical understanding, she defended them
as a vital part of a healthcare system under which seeing a qualified doctor
is beyond the financial means of millions. "You might assume that they are
illiterate and they are quacks and they do not know what they are doing but
that is not true. What we found was that about 30% may even be graduates or
postgraduates," she said, adding that most had worked as doctors' assistants
and continued to be mentored by them.
Informal practitioners are usually respected and important members of their
communities and, when in doubt, often consult qualified doctors on the best
course of action. Dr. Gautham's study also found that they did not prescribe
any "reserve" antibiotics - powerful medications considered a last resort
and therefore used in hospitals as sparingly as possible.
Amid Superbug Scourge, Study Finds 1 in 3 Antibiotic Prescriptions
Unnecessary
New findings shed light on the problem of "superbugs" - antibiotic-resistant
microbes, showing at least 30% of antibiotics in the US are unnecessary.
MintPress News | Andrea Germanos | 01:53 PM
Unfortunately, informal practitioners routinely prescribe less than full
courses of antibiotics, despite the fact that this is a huge driver of
resistance. This is not done out of ignorance, but rather because India is
such an unequal society that poor patients simply cannot afford long courses
of antibiotics. "Packages are customized based on patients' paying capacity.
If the patient cannot afford a full course, then they will be given two or
three days of antibiotics - or even less," Dr. Gautham noted. The effect of
this is that bacterial infections become stronger and more resistant to
treatment with antibiotics. And bacteria do not respect borders.
Consequently, the extreme inequality in much of the Global South is a direct
threat to human survival elsewhere.
Thus, any top down approach simply banning informal practitioners from
handing out antibiotics would surely do more harm than good, given the huge
shortage of qualified doctors. Furthermore, Dr. Sulis's study found that
qualified practitioners were actually more likely to prescribe antibiotics
than the so-called "quacks." This could be because licensed professionals
are subject to exactly the same incentives and financial rewards that their
unlicensed peers are under - a system that also prevails across the United
States.
In 2019, ProPublica found more than 700 American doctors who had received
more than $1 million each from drug and medical device companies. It is
commonplace for U.S. doctors to receive financial and other rewards for
prescribing certain drugs, a system that undermines their neutrality. Across
the world, big pharma wines and dines medical professionals in expensive
resorts, claiming these events are educational conferences. But the line
between informative events and expense-paid vacations is not always easy to
distinguish.
Making a big problem bigger
A second way in which giant pharmaceutical corporations are aiding the
spread of resistance is their refusal to devote the necessary resources
towards replenishing stores of new antibiotics. Investment in the area has
rapidly dwindled. "The big problem is that we do not have any novel
antibiotics in the pipeline that we can expect to see in the near future. So
we really have to protect those that we do have," Dr. Gautham told
MintPress.
And while the Global South overprescribes antibiotics, in the West farm
animals are pumped full of them, farmers even giving them to healthy animals
so they can be packed tighter in ever-increasing herd sizes. The WHO notes
that in many countries, 80% of medically important antibiotic consumption
goes to farm animals and has strongly recommended a wholesale reduction of
the practice.
factory farm
Herds of cattle at a factory farm in Coalinga, California. Gary Kazanjian |
AP
Antibiotics used in farms spill over into the surrounding environment
through run-off and waste, creating resistance to drugs and endangering
human health. Unfortunately, the for-profit corporate agriculture sector has
little regard for the consequences. As one paper in the British Journal of
General Practice noted,
In animals and fish, antibiotics are used as a substitute for good hygiene,
with little understanding of how this might impact on antimicrobial
resistance in humans. As a society we must urgently reconsider how we use
antimicrobials to preserve this valuable resource for future generations."
The hyper-exploitation of animals is also leading to dangerous outbreaks of
zoonotic (animal to human) diseases.
Ultimately, the problem of antibiotic overprescription is structural in
nature, and there is little end to it in sight. As Dr. Sulis told MintPress:
"The industry has no interest at all in raising awareness on the importance
of using antibiotics wisely and the potential implications of inappropriate
use, including overprescription," although she noted that it was difficult
to accurately weigh up the proportion of blame they deserved and to
disentangle their role from other key drivers of the crisis.
New Report Revels Heavy Antibiotic Use In Fast Food Livestock
Though the report focused on antibiotic use, it warned of other additives
used in meat in the United States, including zinc, copper, growth hormones,
and debilitating beta agonists like ractopamine. , antibiotics, fast food,
livestock,
MintPress News | Carey Wedler | 01:50 PM
Nothing to see here, just a looming disaster
The negative effects of this looming scenario are profound. Since the
adoption of penicillin in the 1940s, the widespread use of antibiotics is
estimated to have extended average life expectancy by 20 years. Dr. Gautham
noted that "as antibiotic overuse keeps increasing, then all those
antibiotics that we have today will slowly become ineffective against even
the most common infections."
Thus the conditions of the past will become the maladies of the future.
Cancer treatments such as chemotherapy, cesarean sections, and other common
surgeries will be in major jeopardy, as they require antibiotics to prevent
any post-surgical and opportunistic infections. Healthcare costs will spike
as conditions that were treatable in a few days will draw on for weeks, and
some cases may not be recoverable. As Dr. Sulis warned:
The consequences ultimately affect everyone on the planet. We are already
facing a dramatic increase in incidence of multi-drug- and extremely
drug-resistant infections, but we are running out of effective therapeutic
options. This scenario is bound to get worse over the next few years and, in
the absence of countermeasures, it will have an impact on healthcare as a
whole, not to mention the economic losses."
For such a profound problem, which threatens the very foundation of modern
medicine, the story is receiving barely any attention in the media. Indeed,
so uninterested is the press in pharmaceutical profiteering accelerating
superbugs that media-literacy group Project Censored chose it as one of
their top 25 most censored stories of 2019-2020. The only substantial
corporate reporting on the unethical sale of antibiotics, their research
showed, was a single 2016 investigation by The New York Times.
Unlike with COVID, there is still time to prevent mass suffering. And yet
this systemic problem appears to be getting worse, not better, as we move
closer towards it. If the past year has taught humanity anything, it is that
bugs do not respect borders and increased global planning and cooperation
are vital to meet the planet's most pressing problems head-on.
Unfortunately, it seems we are sleepwalking into another preventable
catastrophe. And few are even talking about it.
